Donor outcomes in anonymous live liver donation
Donor outcomes in anonymous live liver donation
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DOI：
10.1016/j.jhep.2019.06.027
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发表时间：
2019-11-01
影响因子：
25.7
通讯作者：
Grant, David
中科院分区：
文献类型：
--
作者：
Goldaracena, Nicolas;Jung, Judy;Grant, David
背景与目的：肝移植等候名单上的死亡率为5%-25%。在此，我们报告了一个独特的经验与50个匿名的个人谁自愿解决这个差距，提供捐赠他们的肝脏的一部分，收件人与他们没有生物连接或先前的关系，所谓的匿名活体肝脏捐赠（A-LLD）。分析人口统计学和手术结局。捐赠后的定性访谈研究动机和经验。经验证的自我报告问卷评估了人格特质和心理影响。结果：2005年至2017年期间，共进行了50例A-LLD肝移植。大多数捐赠者都受过大学教育，中等收入，有利他主义的历史。一半是女性。中位年龄为38.5岁（范围20-59岁）。33人（70%）通过公共或社交媒体了解到这一机会。拯救生命，帮助他人，繁衍后代，以及对过去慷慨的回报是激励因素。加拿大的社会、财政、保健和法律的支持被确定为促进因素。A-LLD最认同的人格特质是随和和随和。平均住院时间为6天。1例供体出现Dindo-Clavien 3级并发症，已完全消退。22名成人和28名儿童的一年受体存活率分别为91%和97%。没有A-LLD报告后悔他们的decision.Conclusions：这是第一个也是唯一的报告的特点，动机和促进剂的A-LLD在一个大的队列。有了严格的协议，结果是非常好的。A-LLD有显着的潜力，以减少移植器官的需求和availability.Lay之间的差距：我们报告了一个独特的经验，50个活体捐赠者自愿捐赠给收件人，他们没有生物连接或以前的关系（匿名活体捐赠者）。这份报告是第一份讨论动机，策略和促进者，可能会减轻身体，社会和道德风险因素在这一患者群体。通过严格的方案，匿名肝脏捐赠和受体结果非常好;通过适当的临床专业知识和系统促进者，我们的经验表明，其他中心可能会考虑该程序，因为它具有缩小移植器官需求和可用性之间的差距的巨大潜力。(C)2019年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Death rates on liver transplant waiting lists range from 5%-25%. Herein, we report a unique experience with 50 anonymous individuals who volunteered to address this gap by offering to donate part of their liver to a recipient with whom they had no biological connection or prior relationship, so called anonymous live liver donation (A-LLD).Methods: Candidates were screened to confirm excellent physical, mental, social, and financial health. Demographics and surgical outcomes were analyzed. Qualitative interviews after donation examined motivation and experiences. Validated self-reported questionnaires assessed personality traits and psychological impact.Results: A total of 50 A-LLD liver transplants were performed between 2005 and 2017. Most donors had a university education, a middle-class income, and a history of prior altruism. Half were women. Median age was 38.5 years (range 20-59). Thirty-three (70%) learned about this opportunity through public or social media. Saving a life, helping others, generativity, and reciprocity for past generosity were motivators. Social, financial, healthcare, and legal support in Canada were identified as facilitators. A-LLD identified most with the personality traits of agreeableness and conscientiousness. The median hospital stay was 6 days. One donor experienced a Dindo-Clavien Grade 3 complication that completely resolved. One-year recipient survival was 91% in 22 adults and 97% in 28 children. No A-LLD reported regretting their decision.Conclusions: This is the first and only report of the characteristics, motivations and facilitators of A-LLD in a large cohort. With rigorous protocols, outcomes are excellent. A-LLD has significant potential to reduce the gap between transplant organ demand and availability.Lay summary: We report a unique experience with 50 living donors who volunteered to donate to a recipient with whom they had no biological connection or prior relationship (anonymous living donors). This report is the first to discuss motivations, strategies and facilitators that may mitigate physical, social and ethical risk factors in this patient population. With rigorous protocols, anonymous liver donation and recipient outcomes are excellent; with appropriate clinical expertise and system facilitators in place, our experience suggests that other centers may consider the procedure for its significant potential to reduce the gap between transplant organ demand and availability. (C) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.